How Much You Know About Valvular Heart Disease? Trivia Quiz

The most likely diagnosis in this case is mitral stenosis. Mitral stenosis is characterized by a low-pitched mid-to-late diastolic murmur that is heard best at the apex. The loud S1 and the presence of a loud extra sound immediately preceding the murmur are also consistent with mitral stenosis. Mitral valve prolapse, ventricular septal defect, and aortic insufficiency would not typically present with these findings.

The given scenario describes a patient who died after an acute febrile illness, and the lesion observed at autopsy suggests an infection. The most likely finding in the patient's medical record would be a positive culture for Staphylococcus aureus, indicating that the patient had a Staphylococcus aureus infection. The other options, such as elevated anti-streptolysin-O titer, high serum c-ANCA titer, and high p-ANCA titer, are not specifically related to Staphylococcus aureus infection and are less likely to be found in this patient's medical record.

The mechanism for his chest pain is most likely to be a supply/demand imbalance. This is because aortic stenosis, which the patient has, restricts blood flow from the heart to the rest of the body, leading to inadequate oxygen supply to the myocardium. During exercise, the demand for oxygen by the heart increases, but the stenotic aortic valve cannot deliver enough oxygenated blood to meet this demand. This results in chest pain, known as angina pectoris. The symptoms are aggravated during exercise due to the increased demand for oxygen.

WHY are his briefs on backwards??????

About half of the cases of aortic insufficiency are due to the aortic root dilatation (annuloaortic ectasia), which is idiopathic in over 80% of cases, but otherwise may result from aging, syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet's disease, reactive arthritis and systemic hypertension.[2] In about 15% the cause is innate bicuspidal aortic valve, while another 15% cases are due to retraction of the cusps as part of postinflammatory processes of endocarditis in rheumatic fever and various collagen vascular diseases. Additionally, aortic insufficiency has been linked to the use of some medications, specifically medications containing fenfluramine or dexfenfluramine isomers and dopamine agonists.

Other potential causes that affects the valve directly include:

*******MARFAN'S SYNDROME, **********Ehlers–Danlos syndrome, ankylosing spondylitis and systemic lupus erythematosus. In acute cases of aortic insufficiency, the main causes are infective endocarditis ,aortic dissection or trauma.

The most likely diagnosis for this patient is senile calcific aortic stenosis. This is supported by the patient's age (74 years old) and the presence of heavily calcified aortic valve on Doppler ultrasonography. Senile calcific aortic stenosis is a common degenerative condition that occurs with aging, leading to narrowing of the aortic valve and symptoms such as chest pain, shortness of breath, and lightheadedness. The other options, such as aortic stenosis of rheumatic heart disease etiology, aortic stenosis of luetic etiology, aortic stenosis after subacute bacterial endocarditis, and calcific stenosis of congenitally bicuspid valve, are less likely given the patient's age and clinical presentation.

Upon auscultation of an individual with mitral stenosis, the first heart sound is unusually loud and may be palpable (tapping apex beat) because of increased force in closing the mitral valve.

An opening snap which is a high pitched additional sound may be heard after the A2 (aortic) component of the second heart sound (S2), which correlates to the forceful opening of the mitral valve.

A mid-diastolic rumbling murmur with presystolic accentuation will be heard after the opening snap. The murmur is best heard at the apical region and is not radiated. Since it is low-pitched it is heard best with the bell of the stethoscope.

The patient's presentation of cyanosis, pitting edema, distended jugular veins, and hepatosplenomegaly, along with a ventricular septal defect and a harsh holosystolic murmur and thrill at the left sternal border, is consistent with Eisenmenger syndrome. Eisenmenger syndrome is a complication of congenital heart defects, such as a ventricular septal defect, where there is a reversal of shunt flow due to increased pulmonary vascular resistance. This leads to cyanosis and the development of right-sided heart failure. Therefore, Eisenmenger syndrome is the most likely complication in this patient.

pulsus tardus et parvus, also pulsus parvus et tardus, slow-rising pulse and anacrotic pulse, is a sign where, upon palpation, the pulse is weak/small (parvus), and late (tardus) relative to its usually expected character.

It is seen in aortic valve stenosis.

Typical findings in aortic stenosis include a narrow pulse pressure, left ventricular hypertrophy, a harsh late-peaking systolic murmur heard best at the right second intercostal space with radiation to the carotid arteries, and a delayed slow-rising carotid upstroke (pulsus parvus et tardus).[

Congenital bicuspid aortic valve
Aortic valve composed of 2 cusps instead of 3
Results from fusion of two cusps into one during development
May show systolic murmur in early life
Clinical complications:
Aortic stenosis
AORTIC DISSECTION

The squatting position that the child takes helps to relieve the symptoms of Tetralogy of Fallot. This condition involves a combination of heart defects that result in decreased blood flow to the lungs. By squatting, the child increases the resistance in the blood vessels in the legs, which helps to prevent blood from flowing out of the heart too quickly. This allows more blood to flow into the lungs, improving oxygenation and relieving symptoms.

Bacterial Endocarditis:
Major complications
Destruction/rupture of valve
Heart failure
Valve insufficiency
*Septic emboli to other organs and tissues*
Splinter hemorrhages
Janeway lesions/Osler nodes
Roth's spots
Kidney abscesses
Brain infarcts

(middle picture of palm) *Janeway lesion*
non-painful hemorrhagic lesions on palms and soles of feet
*essentially diagnostic of bacterial endocarditis

Histology
Inflammation
Bacterial colonies
Staphylococcus aureus
Pseudomonas aeruginosa

Left atrial failure in a patient with mitral stenosis can be explained by volume overload, pressure overload, and impaired contractility. Mitral stenosis leads to a narrowing of the mitral valve, which obstructs blood flow from the left atrium to the left ventricle. This obstruction causes an increase in pressure within the left atrium, leading to pressure overload. Additionally, the narrowed valve prevents proper emptying of the left atrium, causing blood to accumulate and leading to volume overload. Finally, the continuous strain on the left atrium can result in impaired contractility, further contributing to left atrial failure.

Rheumatic disease can cause both stenosis and regurge in both valves.
It usually affects the M valve first.

Squatting increases thoracic pressure, decreasing right to left shunting. Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.